Why are Workplace Wellness programs not working well?
After being part of the $8 billion Workplace Wellness industry for years and now returning to the “real” world of private practice medicine, I now see why the programs have a hard time convincing us that they actually work by reducing costs of care (and improving quality). The latest research study results from The University of Chicago and Harvard studying a population of employees at BJ Wholesale published in JAMA and referenced by the NPR article showed lackluster results. If my daughter was an HR manager, she would probably read the research and the next time she listened to a sales pitch from a wellness vendor about how effective their services were, she would respond with a single “meh” reflecting that she was not convinced of the value.
A few thoughts after reflecting on this latest study:
1) Workplace Wellness programs were never clearly able to conclusively show a reduction in per member per year cost of healthcare by way of improved health or increased productivity of the employees overall. In 2013, Reuters reported that RAND Corp was congressionally mandated to analyze the success of Workplace Wellness programs and informed the Department of Health and Human Services that these programs had a “modest” effect. Some studies may have shown some promise in the past, but why continue to spend so much money on programs that don’t seem to work?
2) Why don’t wellness programs work well? I jumped on the Workplace Wellness program bandwagon years ago but now I realize that one of their major challenges is that they fragment care. Most people view their healthcare as being centered around their relationship with their primary care physician (PCP). Typically, when the question arises of “are you healthy?”, the answer is dependent on what the PCP said at the last visit. When you have Wellness programs at work, the doctor does not know what the programs are at a particular employer (most primary care doctors have 3,000 to 4,000 patients each with potentially hundreds of employers). As a result, there is minimal connection between what a person usually feels is his/her most trusted advisor and a wellness program that the employer offers through a 3rd party wellness vendor. Some information comes from the doctor and some from the Workplace Wellness program. What should the employee do when there is a conflict? Which health recommendations are reinforced? This results in fragmented healthcare.
3) What can employers do to help their employees be well? Answer: Reinforce the existing (or motivate their employees to create a) primary care physician-patient relationship and pay the PCPs to provide wellness services. Why should they do that? PCPs are at the front line of healthcare. When I have a patient come to my private medical office with back pain as an example, I want them to recover as quickly as possible. I need to provide them the best recommendations based on their specific case including how to prevent a recurrence. If I provide high quality patient care (including referrals to a good physical therapist) then they will come back to me – if I don’t, they won’t. What does paying primary care physicians for wellness mean? Currently, in addition to the $8 billion spent on these wellness programs, most employees spend $5,000 and total premiums for an employee and his/her family on healthcare are nearly $20,000 (according to Kaiser Health News).
Rather than pay PCPs through complicated PPO / HMO / HSA programs, employers should consider a retainer payment model. PCPs would be paid $1,000 – $2,000 per employee or family member to provide comprehensive wellness and illness care. The focus of the PCP shifts from treating a panel of 3,000 – 4,000 people for illness to helping a panel of 300 – 400 people be well and the PCP would be able to provide customized and coordinated Wellness programs that will actually work well.
Decisions related to health and wellness are very personal ones and supporting people to make good ones must be done in a manner that accommodates individual preferences in terms of nutrition, activity, and social/mental wellbeing. Centering care around PCPs makes sense – unfortunately, workplace wellness programs as they are designed today conflict with this practical approach. Wellness programs can work if they build on the existing healthcare system rather than further fragmenting it.